Iliotibial band syndrome - symptoms and treatment of ITBS

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation NATALIA REKE
Date added 31.12.2024
Date of last revision 31.12.2024

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Illiotibial band syndrome (ITBS) is a fairly common knee joint strain that manifests itself as pain when running and tenderness when touching the lateral aspect of the knee. It is considered a typical overload injury, most often affecting runners and cyclists with poor motor training and poor training habits.

Table of contents:

What is the iliotibial band?

The iliac-tibial band is a thick band of fascia that runs along the side of the thigh. It extends from the hip joint with an attachment at the iliac crest, all the way to the knee joint, attaching to the lateral condyle of the femur, the lateral trochlea of the patella and Gerdy's bump. The iliac-tibial band is made up of three tendinous bands, which are extensions of the muscles: the broad fascia stressor, gluteus maximus and gluteus medius.

Its anatomical structure makes it play an important role, the main function being to inhibit adduction and stabilize the knee in an upright position. At its end, the iliac-tibial band connects to the tibia, providing support and stability for the knee joint. This is where the pain and inflammation that characterizes ITBS most often occurs.

What are the symptoms of patellofemoral band syndrome?

  • Pain on the outside of the knee, which is usually pinpoint and can occur both during and after physical activity.
  • Gradual increase in pain during: running (especially when the heel hits the ground), walking up stairs, cycling or performing similar activities that require bending and straightening the knee.
  • Swelling localized to the area where the band attaches to the tibia.
  • Post-exercise tenderness in the area of the lateral epicondyle of the femur.
  • Possible audible crackling when bending the knee, due to the band moving over the bony cusp.

What are the causes of iliotibial band syndrome?

  • The most common causes contributing to ITBS are related to excessive tension and irritation of the iliotibial band during physical activity.
  • Repetitive movements, such as running on uneven terrain, prolonged workouts or increased intensity of physical activity, can induce strain on the iliopsoas girdle, leading to irritation and inflammation.
  • Improper running technique or performing other physical activities with improper technique can put undue stress on the iliotibial band.
  • Not warming up properly before physical activity and not stretching the muscles after training can increase the risk of ITBS.
  • Poor muscle strength in the hip, gluteal and thigh areas can contribute to excessive tension on the iliotibial band.
  • Dysbalances in muscle strength, especially between the external and internal muscles of the hip, can affect the biomechanics and stress on the hip-belt.
  • Chronic inflammation can increase the risk of ITBS.
  • Improperly fitting athletic shoes or insoles with poor foot support can affect the biomechanics of running or walking, which can contribute to ITBS.
  • The anatomical structure of the lower extremities (e.g., valgus knees or knock-knees) may predispose to the syndrome.

What is the diagnostic process for iliotibial band syndrome?

Diagnosis of iliotibial band syndrome (ITBS) usually involves several elements to rule out other causes of knee pain and to confirm the area of the iliotibial band as the main cause of the condition. The orthopedist takes a detailed medical history, asking about the patient's symptoms, history of injury, type of physical activity practiced, intensity of training and other factors that may contribute to the onset of the condition. The doctor or physiotherapist performs a thorough physical examination, focusing on the area of the knee, hip, buttocks and thigh, looking for characteristic pain points and assessing the range of motion, flexibility and muscle strength in the area.

The doctor must rule out other causes of knee pain that may have similar symptoms, such as ligament damage, meniscus problems, arthritis or arthritis. During the physical examination, special functional tests may be performed to help assess the involvement of the patellofemoral girdle, such as the Noble test, Ober test or knee flexion resistance test.

In some cases, if the diagnosis is in doubt or treatment is not improving, the doctor may order imaging studies such as magnetic resonance imaging (MRI) or ultrasound. These tests allow a more accurate assessment of anatomical structures and possible damage.

It is worth noting that an accurate diagnosis of ITBS can be difficult, as knee pain can be caused by many different factors. Therefore, it is important to consult an experienced orthopedic or rehabilitation specialist, who will be able to accurately assess symptoms, rule out other causes of pain and establish the correct diagnosis.

How is hip-band syndrome treated?

The most important information is that iliac tibial band syndrome is most often treated non-surgically, with physiotherapy playing a key role. The first area to look at in the treatment of ITBS is the modification of physical activity to prevent further worsening of the patient's symptoms. It is advisable to consult with a Rehasport motor preparation trainer, who will help introduce a period of active rest, significantly reducing training load and intensity. The goal is to introduce other physical activities, such as swimming, that do not exacerbate symptoms, but maintain fitness. Unfortunately, with aggravated symptoms, this may not be radical enough, so some specialists suggest a complete rest from sports activities for at least three weeks.

ITBS treatment vs. rehabilitation

Crucial to the treatment of iliac-tibial band syndrome is physiotherapy. Rehabilitation exercises, prepared in by an experienced therapist, may include stretching and strengthening elements, especially for the hip and thigh muscles. The goal is to improve stability of the hip joint and knee, which can reduce stress on the iliotibial band. Rolling the hip and tibialis bands with a foam roller has good results. Importantly, the patient can perform these exercises at home, for self relaxation and muscle stretching.

For some people struggling with hip and tibialis band syndrome, the discomfort may be due to improper running technique - hence the injury is sometimes referred to as runner's knee, or improper movement patterns. It is therefore advisable to consult a specialist to correct running technique, which can help reduce pain and prevent future problems. An orthopedist or physiotherapist may also suggest changing running shoes with proper support or using personalized orthotic inserts, which can help improve gait and running biomechanics.

In more difficult cases, the orthopedist may recommend drug treatment - non-steroidal anti-inflammatory drugs, steroid injection in the hip-band area or cryotherapy. Always keep in mind that every case of ITBS is different, and it is best to consult a professional, such as a physiotherapist or orthopedic doctor, who can suggest a customized treatment plan.

Surgical treatment for iliotibial band syndrome

Surgical treatment of ITBS is extremely rare. In cases refractory to rehabilitation or in recurrent cases, where all conservative treatment options have been exhausted, i.e. rehabilitation, physical therapy and injections, the doctor may opt for surgical treatment. This is a small procedure performed in the open, which consists in plasty - reducing the tension in the distal part of the iliac tibial band, exactly where the conflict occurs, i.e. friction of the band against the lateral epicondyle of the femur. After such an operation, the patient uses elbow crutches for a period of 2-3 weeks for pain relief. Return to full sports load occurs 6-8 weeks after the surgery.

How to avoid the occurrence of hip-belt syndrome?

  • Correct technique - it is worthwhile to ensure correct running technique, which can keep us from putting too much stress and strain on the hip and tibialis band.
  • Stretching and strengthening - it's worthwhile to regularly do stretching and strengthening exercises, especially for the hip and gluteal muscles that stabilize the hip and tibialis girdle.
  • Rest and recovery - it is very important to remember to rest and recover between workouts.
  • Overtraining can lead to overtraining and injuries, including ITBS.
  • Gradual increase in load - if you are a beginner runner or returning to training after an injury, avoid rapidly increasing the distance or intensity of your runs.
  • Well-chosen footwear - the right sports equipment plays a key role in the training process, so make sure you have good running shoes and personalized orthotic insoles.
  • Keep in mind that these tips can only help reduce the risk of ITBS, but this is not always possible. If you start experiencing pain in the knee area that does not subside after rest and home remedies, it is always worth consulting an orthopedist or physical therapist.

Related articles:

Learn about other possible injuries to the knee joint.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
NATALIA REKE
NATALIA REKE

Fizjoterapeutka w Rehasport, specjalistka od terapii bólu, stanów przeciążeniowych kończyny górnej i dolnej. Zajmuje się neurodynamiką (pracą na nerwach, koordynacji i sile mięśniowej) problemami kręgosłupa (dyskopatii, dysfunkcji stawowych), a także rehabilitacją kobiet w ciąży.

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